A pessary is a removable silicone device placed inside the vagina to support pelvic organs that have shifted out of position or to prevent urine leakage. It works like an internal brace, holding up the bladder, uterus, or rectum when the muscles and tissues of the pelvic floor can no longer do the job on their own. Pessaries are one of the oldest tools in gynecology, and they remain a first-line, nonsurgical option for two very common conditions: pelvic organ prolapse and stress urinary incontinence.
What a Pessary Treats
Pelvic organ prolapse is the most common reason a pessary is prescribed. Prolapse happens when the muscles and connective tissue that hold your pelvic organs in place weaken, allowing the bladder, uterus, or rectum to drop downward and press into or bulge through the vaginal wall. You might feel a heavy, dragging sensation, notice a bulge at the vaginal opening, or have trouble emptying your bladder or bowels completely. Pregnancy, childbirth, aging, and menopause all increase the risk.
Stress urinary incontinence is the second major use. This is the type of leakage that happens when you cough, sneeze, laugh, lift something heavy, or exercise. A pessary designed for incontinence supports the urethra and gently compresses it against the pubic bone, increasing resistance so urine doesn’t escape when pressure in your abdomen spikes. It functions in much the same way a surgically implanted sling would, but without an operation.
How Different Types Work
Pessaries come in a surprisingly wide range of shapes and sizes, each suited to a different degree of prolapse or a different anatomy. They fall into a few broad categories.
Support pessaries prop organs up from below. The ring pessary is the most commonly recommended starting point. It’s O-shaped, flexible, and works well for mild to moderate prolapse and stress incontinence. Some ring pessaries have a small knob or thickened area that sits under the urethra to provide extra support against leakage.
Space-filling pessaries are designed for more advanced prolapse, where organs have dropped significantly. The Gellhorn pessary is a common example. It has a flat disc on top and a stem below, and once inserted, it creates suction against the vaginal walls to hold prolapsed tissue back in place. The donut pessary looks like a thick ring and fills more of the vaginal space. The cube pessary grips the vaginal walls through suction on each of its six faces, making it useful when other types won’t stay in.
Lever pessaries (Smith, Hodge, Risser) are narrower, curved devices that work by repositioning a tilted uterus or supporting a specific area of the vaginal wall. They’re less commonly used than rings or Gellhorns but have a role in particular anatomical situations.
What the Fitting Process Looks Like
Getting a pessary isn’t a one-visit-and-done process. Your provider will do a pelvic exam to assess the type and severity of prolapse, then select a style and size to try first. The pessary is lubricated and inserted by hand, folded or compressed to fit through the vaginal opening, then allowed to expand into position. You’ll typically be asked to stand up, walk around, sit, cough, and bear down to make sure the device stays in place and feels comfortable. If the first one doesn’t work, a different size or type is tried. It can take two or three visits to find the right fit.
A properly fitted pessary shouldn’t cause pain. You shouldn’t feel it once it’s in place, and it shouldn’t interfere with urination or bowel movements. If it does, it’s the wrong size or type.
Living With a Pessary Day to Day
Many people wear a pessary continuously, removing it only for cleaning. The general recommendation is to take it out and wash it with mild soap and water once or twice a week, though some providers advise nightly removal. Ring pessaries are the easiest to manage yourself because they fold for insertion and removal, similar to a diaphragm. Gellhorn and cube pessaries are trickier, and some people prefer to have their provider handle removal and cleaning at regular office visits instead.
Research on long-term continuous wear suggests that a ring pessary can be left in place for up to two years in women who have had a hysterectomy, and up to four years in those who haven’t, provided there are no complications. That said, regular check-ins with your provider are important regardless of how long the pessary stays in.
Vaginal estrogen cream is often prescribed alongside a pessary, especially for postmenopausal women. Lower estrogen levels after menopause thin the vaginal lining, making it more vulnerable to irritation from the device. Topical estrogen restores moisture and thickness to the tissue, reducing the risk of erosion and discomfort. It’s typically applied a couple of times per week.
Possible Side Effects
Most people tolerate a pessary well, but side effects do occur, particularly with long-term use. The most common issues are increased vaginal discharge, minor irritation or erosion of the vaginal lining, and occasional spotting or bleeding. Some women notice an odor. These problems are generally mild and resolve with temporary removal of the device, a short rest period, and sometimes a switch to a different type or size.
Vaginal erosion, where the tissue develops a raw or abraded area, is the complication providers watch for most carefully. It shows up as unusual discharge (sometimes blood-tinged), spotting, or a foul smell. The main risk factors are wearing a pessary that’s too large or leaving it in for extended periods without removal. If erosion happens, the typical approach is to take the pessary out for about two weeks to let the tissue heal, often with vaginal estrogen to speed recovery.
Serious complications are rare but possible with neglected pessaries. A device left in for months or years without any check-ups can become embedded in the vaginal wall or, in extreme cases, erode into the bladder or rectum. These outcomes are almost entirely preventable with routine follow-up.
How Well They Work Long Term
Pessaries have strong long-term adherence. In one retrospective study following women for up to 15 years, nearly half continued using their pessary throughout the entire follow-up period. Among those who stopped, only about 7% cited general dissatisfaction with the device. The rest discontinued for other reasons, including choosing surgery, resolving symptoms through other means, or developing a complication that required a break.
For stress incontinence specifically, pessaries reduce or eliminate leakage in a large proportion of women who use them. They’re particularly useful for people who leak mainly during exercise or physical activity, since the device can be inserted just for those occasions and removed afterward.
Pessary vs. Surgery
A pessary isn’t a lesser alternative to surgery. It’s a legitimate long-term treatment that many women prefer precisely because it’s reversible, avoids surgical risks, and can be started and stopped at any time. It’s often the first option offered, with surgery reserved for cases where a pessary can’t be fitted, doesn’t stay in place, or doesn’t relieve symptoms adequately.
People who are pregnant, planning future pregnancies, recovering from other conditions, or simply not interested in surgery are all good candidates. There’s no time limit on how long you can use one, as long as it’s monitored. Some women use a pessary for decades without ever needing surgical repair.